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Hypopharyngeal Multichannel Intraluminal Impedance Improves the Outcome of Antireflux Surgery on Patients With Laryngeal Symptoms
Yoshihiro Komatsu*, Toshitaka Hoppo, Blair a. Jobe
Institute for the Treatment of Esophageal and Thoracic Disease, Allegheny Health Network, Pittsburgh, PA
Introduction: Patient selection is critical for the successful surgical treatment of gastroesophageal reflux disease (GERD). Previously, we established the normative data of laryngopharyngeal reflux (LPR) and high-esophageal reflux (HER: reflux up to 2cm distal to upper esophageal sphincter) events for 24-hour hypopharyngeal multichannel intraluminal impedance (HMII). Based on the data, we have constructed the criteria to define "abnormal proximal exposure (APE)" as LPR ≥1/day and/or HER ≥5/day. Previous retrospective analyses have suggested that HMII may increase the sensitivity in selecting patients with LPR symptoms who likely respond antireflux surgery (ARS). The purpose of this study was to objectively evaluate the outcome of ARS on patients selected based on our criteria by using validated questionnaires.
Methods: This is a retrospective review of prospectively collected data from patients who underwent HMII. Patients with APE as measured by HMII and subsequently underwent ARS, were identified. The outcome of surgery included improvement in clinical symptoms and quality of life, both of which were assessed based on the personal interview and the validated questionnaires such as GERD-HRQL, Respiratory Symptom Index (RSI) and SF-36 before and after ARS.
Results: From September 2012 to October 2013, 171 patients underwent HMII. Of 118 patients with APE, 26 patients underwent ARS (7 men and 19 women; mean age 51.6). Twenty-one patients (81%) had LPR symptoms including cough (n=20), throat burning (n=3), cervical dysphagia (n=3), throat tightness/pressure (n=2), and hoarseness (n=1). Of 21 with LPR symptoms, 11 (42%) had concomitant typical GERD symptom such as heartburn and regurgitation. The mean DeMeester score was 15.7 (range 1-54.8) and 15 patients (58%) had negative DeMeester score. Clinical symptoms completely resolved in 20 patients (77%) and significantly improved in 5 patients (19%) at 6 weeks after the surgery. Anti-secretory medications were discontinued in 25 patients (96%) at a mean follow-up period of 2.1 months (0.36-5.3). Complete validated questionnaires before and after ARS were available for 11 patients. Of them, there was a significant improvement in GERD-HRQL (Pre-op 20.7; post-op 6.9, p= 0.016) and RSI scores (Pre-op 23.9; post-op 15, p=0.001) post-operatively. However, there was no significant difference in SF-36 scores on either physical component scores (pre-op 33.6; post-op 32.8, p=0.853) or mental component scores (pre-op 44.7; post-op 47.5, p=0.49).
Conclusion: APE as measured by HMII, regardless of whether there is positive DeMeester score, may identify patients with laryngeal symptoms, who likely respond ARS, potentially improving the surgical outcome. Data set is currently being expanded and will be presented at the conference.
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